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 <div>&nbsp;</div>
 <div>&nbsp;</div>
 <div style="margin:20px auto 0 auto; width:680px">
 	<h1 style="text-align:center">四川省因公出国电子护照申请表</h1>
    <div style="text-align:left; margin-bottom:10px; margin-top:0px; font-size:16px">
    	&nbsp;&nbsp;&nbsp;&nbsp;申报单位名称：
 </div>
 <div>
   <table border="1" cellpadding="0" cellspacing="1" width="680px" style="text-align:center;">
   	<tr>
      <td width="80">
      	中文姓
      </td>
      <td width="90">&nbsp;
      	
      </td>
      <td width="80">
      	中文名
      </td>
      <td width="90">&nbsp;
      	
      </td>
      <td width="80">
      	性别
      </td>
      <td width="80">&nbsp;
      	
      </td>
      <td width="90">
      	出生地
      </td>
      <td width="90">&nbsp;
      	
      </td>
    </tr>
   	<tr>
      <td width="80">
      	姓拼音
      </td>
      <td width="90">&nbsp;
      	
      </td>
      <td width="80">
      	名拼音
      </td>
      <td width="90">&nbsp;
      	
      </td>
      <td width="80">
      	民族
      </td>
      <td width="80">&nbsp;
      	
      </td>
      <td width="90">
      	出生日期
      </td>
      <td width="90">&nbsp;
      	
      </td>
    </tr>
    <tr>
      <td colspan="2">
      	工作单位及职务
      </td>
      <td colspan="4">&nbsp;
      	
      </td>
      <td width="90">
      	户口所在地
      </td>
      <td width="90">&nbsp;
      	
      </td>
    </tr>
    <tr>
    	<td colspan="2">
        	证件名称
        </td>
        <td colspan="3">
        	<input type="checkbox" name="checkbox1" id="checkbox" />
            <label for="checkbox1">&nbsp;身份证&nbsp;&nbsp;&nbsp;</label>
            <input type="checkbox" name="checkbox" id="checkbox" />
            <label for="checkbox">&nbsp;军官证&nbsp;</label>
        </td>
        <td>
        	证件号码
        </td>
        <td colspan="2">&nbsp;
        	
        </td>
    </tr>
    <tr>
      <td colspan="2">
      	职业属性
      </td>
      <td colspan="6" style="text-align: left; vertical-align: middle;">
      	<input type="checkbox" name="cb1" id="cb1" />
        <label for="cb1">&nbsp;国家公务员&nbsp;</label>
        <input type="checkbox" name="cb2" id="cb2" />
        <label for="cb2">事业单位人员&nbsp;</label>
        <input type="checkbox" name="cb3" id="cb3" />
        <label for="cb3">军人&nbsp;</label>
        <input type="checkbox" name="cb4" id="cb4" />
        <label for="cb4">国企人员&nbsp;</label>
        <input type="checkbox" name="cb5" id="cb5" />
        <label for="cb5">非国企人员&nbsp;</label>
        <input type="checkbox" name="cb6" id="cb6" />
        <label for="cb6">其他</label>
      </td>
    </tr>
    <tr>
    	<td colspan="2">
        	行政级别
        </td>
        <td colspan="6" style="text-align:left; vertical-align:middle;">
		<input type="checkbox" name="cb1" id="cb1" />
        <label for="cb1">&nbsp;正副省级&nbsp;</label>
        <input type="checkbox" name="cb2" id="cb2" />
        <label for="cb2">正副厅局级&nbsp;</label>
        <input type="checkbox" name="cb3" id="cb3" />
        <label for="cb3">正副县处级&nbsp;</label>
        <input type="checkbox" name="cb4" id="cb4" />
        <label for="cb4">普通&nbsp;</label>        
        </td>
    </tr>
    <tr>
    	<td colspan="2">
        	数字照片编号
        </td>
        <td colspan="3">&nbsp;
        	
        </td>
        <td colspan="2">
        	配偶姓名
        </td>
        <td>&nbsp;
        	
        </td>
    </tr>
    <tr>
    	<td colspan="2">
        	对外身份（选填）
        </td>
        <td colspan="6">&nbsp;
        	
        </td>
    </tr>
   </table>
   <table border="1" cellpadding="0" cellspacing="1" width="680px" style="text-align:center">
   	    <tr>
    	<td width="400" rowspan="1000"style="border-bottom-width:0; border-top-width:0; text-align:center;">
            身份证/军官证复印件
        </td>
        <td width="280" style="border-bottom-width:0; border-top-width:0; text-align:center; ">
        	<div style="margin:10px auto 0 auto; width:120px; height:150px; border-width:1px; border-style:solid;">
           		<br />
                <br />
                <br />
                <br />
                照片	
            </div>
        </td>
    </tr>
    <tr>
    	<td style="text-align:left; border-bottom-width:0; border-top-width:0;">
        	&nbsp;&nbsp;&nbsp;&nbsp;粘贴一张两寸正面免冠近照，另备一张两寸数码照片供制证用，照片背景为白色
        </td>
    </tr>
    <tr>
        	<td style="text-align:left" >
            	&nbsp;&nbsp;&nbsp;&nbsp;签<br />
                &nbsp;&nbsp;&nbsp;&nbsp;名<br />
            </td> 
    </tr>
	<tr>
    	<td style="text-align:left; border-bottom-width:0; border-top-width:0" >
        请本人在上框内签名，不要出框或压框线。此签名将打印在护照上，作为持照人签名。
        </td>
    </tr>
   </table>
   <table border="1" cellpadding="0" cellspacing="1" width="680px" style=" text-align:center">
   <tr>
   	<td colspan="8" style="text-align:left;">
    	&nbsp;&nbsp;&nbsp;备注：
    </td>
   </tr>
   </table>
 </div>
 <div style="text-align:left; margin-bottom:10px; margin-top:0px; font-size:16px">
 	&nbsp;&nbsp;&nbsp;&nbsp;联系人姓名：&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;联系人电话：
 </div>
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